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Postoperative management of total elbow arthroplasty: Results of a European survey among orthopedic surgeons. Dam, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study : Therapeutic Topic : Total elbow replacements - Loading This survey assessed the postoperative management of Total Elbow Arthroplasty (TEA) among 54 orthopedic surgeons across 17 countries. Key findings revealed differences in immobilisation duration, activity restrictions, and protocols for primary versus revision surgeries. Nearly half of the respondents noted variations between primary and revision TEAs, with more restrictive measures often applied post-revision surgery. The research underscores the lack of consensus among surgeons, potentially contributing to low TEA survival rates due to complications like loosening, possibly linked to overloading. Seventy percent of the surgeons suggested a maximum elbow loading of 1-5 kgs and 10% deemed 1 to 10 kg loading being acceptable. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, there is significant variability in terms of recommendations for Total Elbow Arthroplasty (TEA) loading. The large majority of surgeon suggest a maximum loading of 1-5 kg with the most adventurous suggesting that loading can reach 10 kg. Overall the survival rate of a TEA is 90% at 10 years . However, for males, it appears that TEA survival is significant lower, with a 50% chance of needing a revision after 10 years . As for the majority of upper limb presentations, those patients with a TEA and lower social determinants of health, tend to have worse outcomes . URL : https://doi.org/10.1371/journal.pone.0277662 Abstract Background: The number of complications after total elbow arthroplasty (TEA) is high and survival rates are low compared to hip and knee arthroplasties. The most common reason for revision is aseptic loosening, which might be caused by overloading of the elbow. In an attempt to lower failure rates, current clinical practice is to restrict activities for patients with a TEA. However, postoperative management of TEA is a poorly investigated topic, as no evidence-based clinical guidelines exist and the aftercare is often surgeon-based. In this study we evaluated the current postoperative management of TEA among orthopedic surgeons. Methods: An online survey of 30 questions was sent to 635 members of the European Society for Surgery of the Shoulder and the Elbow (SECEC/ESSSE), about 10% (n = ± 64) of whom are considered dedicated elbow specialists. The questions were on characteristics of the surgeon and on the surgeon’s preferred postoperative management, including items to be assessed on length of immobilization, amount of weight bearing and axial loading, instructions on lifelong activities, physiotherapy, and postoperative evaluation of the elbow. Results: The survey was completed by 54 dedicated elbow specialists from 17 different countries. Postoperative immobilization of the elbow was advised by half of respondents when using the triceps-sparing approach (52%), and even more with the triceps-detaching approach (65%). Postoperative passive movement of the elbow was allowed in the triceps-sparing approach (91%) and in the triceps-detaching approach (87%). Most respondents gave recommendations on weight bearing (91%) or axial loading (76%) by the affected elbow, but the specification shows significant variation. Conclusion: The results from this survey demonstrate a wide variation in postoperative care of TEA. The lack of consensus in combination with low survival rates stresses the need for clinical guidelines. Further research should focus on creating these guidelines to improve follow-up care for TEA. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Surgical treatments of post-traumatic elbow stiffness: A systematic review and meta-analysis. Khorram, et al. (2025) Level of Evidence: 1a- Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Post-traumatic elbow stiffness - Surgery This systematic review assessed the impact of surgical interventions have on elbow range of movement, pain, function, and complications for people with post-traumatic elbow stiffness. A total of 99 studies were included, with the majority being retrospective studies. The interventions analysed included arthroscopy, open arthrolysis with or without external fixation. The results showed that all interventions provided with statistically and clinically relevant improvement in range of movement, pain, and function. Complications were around 3%, however, open arthrolysis with external fixation had a much greater risk of nerve injury (9%) compared to open arthrolysis alone or arthroscopy. Figure 2. Forest plot of Range of Motion (ROM) improvement Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, surgical interventions such as arthroscopy or open arthrolysis seem to have a large statistically significant and clinically relevant effect on improving pain, range of movement, and function in people with post-traumatic elbow stiffness . Those people undergoing external fixation seem to have a much greater risk of having a nerve lesion and should therefore be followed more closely. If you would like to determine which of your patients are more likely to benefit from this surgery, have a look at this prediction model . Have a look at the entire database on the topic! URL : https://doi.org/10.1016/j.jse.2025.05.004 Abstract Background: Surgeons may choose between open vs. arthroscopic arthrolysis to address a post-traumatic elbow stiffness (PTES) based on their proficiency in elbow arthroscopy, the ulnar nerve condition, the presence and location of heterotopic ossification, the degree of contracture, and the extent of articular surface damage. This systematic review and meta-analysis aims to compare the effectiveness, range of motion (ROM), and complication rates between open and arthroscopic release in patients with PTES. Methods: The Preferred Reporting Item for Systematic Reviews and Meta-Analyses guidelines were utilized to conduct a systematic review and meta-analysis on surgical treatment for PTES. Comprehensive search was conducted in PubMed, Web of Sciences, Medline, and Scopus from their inception to January 2024. A total of 3,278 records were screened, of which 99 studies on the adult population were included. Outcome variables were changes in the ROM, visual analog scale score, Mayo Elbow Performance Index, and complication rate. Surgical techniques were grouped as arthroscopic, open arthrolysis, and open arthrolysis with external fixator. Results: ROM, visual analog scale, and Mayo Elbow Performance Index improved in patients with PTES after all surgical techniques. Open arthrolysis with external fixation had the highest ROM improvement but also the highest rate of nerve injury. Other variables did not show statistically significant differences among the modalities. Conclusion: Since the overall results of open and arthroscopic arthrolysis for PTES are comparable, the surgeon's expertise and the patient's condition are more important factors to consider when choosing a surgical technique over another. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Zone-specific pitfalls in flexor tendon rehabilitation: Management and prevention. Chinchalkar, et al. (2025) Level of Evidence: 5 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Flexors repair - How to avoid adhesions This is an expert opinion on flexor tendon repair and rehabilitation. The authors highlight the complexity of these injuries and potential for functional impairment due to their intricate anatomy. Adhesions are one of the primary complications, which can hinder tendon gliding and lead to limited finger mobility. Early mobilisation, selective motion blocking splints, and specialised exercises (see figures and ideas below) are critical for restoring function and minimising these issues. Additionally, the article highlights specific complications like the Quadriga phenomenon (gapping of the tendon repair with lag of affected, or adhesion of affect side limiting finger flexion across affected and unaffected fingers), where excessive shortening or adhesions in one digit restricts movement in adjacent fingers, and Lumbrical plus (FDP avulsion/repair failure distal to lumbricals leading to pipj extension during finger flexion) causing paradoxical joint extension during flexion. Once established, this issues can necessitate surgical intervention, however, rehab has the potential to prevent them. ZONE I AND II - SCRATCH YOUR INDEX FINGER! ZONE III - GET THAT HOOK FIST GOING! ZONE IV and V - I AM AN INDEPENDENT FINGER! Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, early mobilisation, splinting, and exercises have all got strong evidence in their support following flexors repair. Early mobilisation (Level 1-2) is supported by numerous studies, including randomised controlled trials, showing effectiveness in preventing adhesion and promoting recovery. Motion-blocking splints (Level 1-2) have also large evidence from clinical studies supporting their protective role in tendon healing. Exercises as well (Level 1-2) are supported by strong evidence from both clinical and experimental studies. Zone-specific rehab protocols have varying level of evidence and there are no specific protocol for all zones. Remember that flexor tendon outcomes tend to be worse in people with lower social determinants of health and that Zone I and II tend to be at greater risk . Hence, we should monitor these people more closely. If you are interested in the topic, have a look at the entire dataset, we have lots of synopses and case reports! URL : https://doi.org/10.1177/17531934241265579 Abstract Despite significant advancements in flexor tendon repair techniques and rehabilitation strategies, achieving complete restoration of digital motion remains a formidable challenge. The most prevalent complications associated with tendon repair are the development of tendon adhesions and joint contractures. Left unaddressed, these complications can further lead to secondary pathomechanical changes, resulting in fixed deformities significantly affecting hand function. This review of zone-specific considerations in flexor tendon rehabilitation provides an in-depth analysis of the dynamics of tendon motion after repair and strategies to minimize common secondary complications. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Volar plate repair for chronic injury. Buldo-Licciardi, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Chronic volar plate injury - Surgery This retrospective study evaluates the long-term outcomes of volar plate repair for chronic finger injuries, focusing on patient satisfaction, pain relief, and joint mobility. A total of ten patients with an average of 9 years (range 10 months to 30 years) between injury and surgery were included. Results indicated high levels of satisfaction, with nine patients reporting "extremely satisfied" and one "satisfied". Pain was completely alleviated in all participants, and significant improvements were observed in joint function. Pre-surgery, pipj hyperextension ranged from 15 to 60 degrees. Post-surgery, six patients achieved normal extension (0–3 degrees), three had minor flexion contractures (5 to 20 degrees), and one experienced a subsequent injury. Radiographic analysis showed minimal degenerative changes in four patients (not all patients agreed to a follow up x-ray). Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, volar plate repair for chronic finger injuries may be useful in reducing hyperextension, pain, and improve patient's satisfaction . If you would like to know more about the pipj and their management following injury, have a look at the entire database . URL : https://doi.org/10.1016/j.jhsg.2025.100776 Abstract Purpose: The aim of this study was to assess the long-term outcomes of volar plate repair for chronic injury. Methods:Patients who underwent volar plate repair for chronic instability more than 6 months following the initial injury were included. A minimum follow-up of 2 years from time of surgery was required. Outcome measures included range of motion, the upper extremity QuickDASH (Disabilities of the Arm, Shoulder, and Hand) score, return to work, return to sport, and plain radiographs. Results:Ten patients were included. The mean time from injury to repair was 9 years, ranging from 10 months to 30 years. The digits involved included one thumb, four ring fingers, and five small fingers. Nine reported being extremely satisfied, and one reported being satisfied with their outcome at final follow-up. Nine of ten reported pain as their initial symptom, and none reported pain at final follow-up. Prior to surgery, all patients had proximal interphalangeal hyperextension ranging from 15° to 60°, three of which were classified as swan neck deformities. At final follow-up, nine patients had extension ranging from 0° to 3°. In addition, one patient had a hyperextension of 25°, although this patient had a subsequent injury. All had full flexion of their proximal interphalangeal joint at final follow-up. The three subjects who reported occupational impairment prior to surgery had no functional limitations following surgery. Two subjects whose injuries led to sport limitations reported returning to their preinjury level of sport. Conclusions: Volar plate repair for chronic injury resulted in successful outcomes based on satisfaction, QuickDASH score, physical examination, and radiographic images. These benefits were noted in a repairs performed decades after injury. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Prognostic factors associated with failure of total elbow arthroplasty. Hamoodi et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Prognostic Topic : Total elbow arthroplasty - Failure risk factors This systematic review and meta-analysis assessed prognostic factors associated with failure requiring revision surgery following Total Elbow Arthroplasty (TEA). More than 30,000 patients with TEA across 19 studies were included. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was utilised to assess the overall quality of evidence. The results showed that there was low or very low quality of evidence suggesting that being male and having had TEA following trauma increased the risk of TEA failure. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, Total Elbow Arthroplasty (TEA) failures may be more likely in males and when TEA was implemented following trauma . The findings from this review appear to be in line with a previous retrospective study showing that TEA following trauma is associate with more complications, including elbow stiffness . Other factors that appear to negatively influence TEA outcomes include lower social determinants of health . For a deep dive on TEA, have a look at the full database . URL : https://doi.org/10.1302/2046-3758.135.BJR-2023-0281.R1 Abstract Aims: The aims of this study were to identify and evaluate the current literature examining the prognostic factors which are associated with failure of total elbow arthroplasty (TEA). Methods: Electronic literature searches were conducted using MEDLINE, Embase, PubMed, and Cochrane. All studies reporting prognostic estimates for factors associated with the revision of a primary TEA were included. The risk of bias was assessed using the Quality In Prognosis Studies (QUIPS) tool, and the quality of evidence was assessed using the modified Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. Due to low quality of the evidence and the heterogeneous nature of the studies, a narrative synthesis was used. Results: A total of 19 studies met the inclusion criteria, investigating 28 possible prognostic factors. Most QUIPS domains (84%) were rated as moderate to high risk of bias. The quality of the evidence was low or very low for all prognostic factors. In low-quality evidence, prognostic factors with consistent associations with failure of TEA in more than one study were: the sequelae of trauma leading to TEA, either independently or combined with acute trauma, and male sex. Several other studies investigating sex reported no association. The evidence for other factors was of very low quality and mostly involved exploratory studies. Conclusion: The current evidence investigating the prognostic factors associated with failure of TEA is of low or very low quality, and studies generally have a moderate to high risk of bias. Prognostic factors are subject to uncertainty, should be interpreted with caution, and are of little clinical value. Higher-quality evidence is required to determine robust prognostic factors for failure of TEA. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Brachial artery injury as a complication of closed elbow dislocation, and disguised as compartment syndrome. Khakbaz, et al. (2023) Level of Evidence: 5 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Diagnostic Topic : Simple dislocation - Vascular lesions A 53 years old patient presented to ED following an elbow dislocation due to a FOOSH, which spontaneously reduced after standing up from the fall. The patient reported extreme pain, radial artery pulselessness, forearm edema, hand numbness, and no clear fracture signs on X-rays, though CT revealed small non-displaced radial and medial condile fractures. The initial diagnosis was acute compartment syndrome (ACS). Surgical intervention included fasciotomy for suspected ACS. Unfortunately, during fasciotomy, the surgeon realised that there was no increase pressure within the forearm compartment, but there was evidence of a ruptured brachial artery. A repair was attempted but the patient was pulseless on the radial side. They underwent further vascular surgery during which a lower limb vein was utilised for an autologous graft. At two years follow-up, full extension of the elbow was still impaired with ongoing pain at the surgical site and radial hand numbness. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, despite neurovascular traumatic events being rare following simple elbow dislocations, these should be kept into consideration as differential diagnoses. Another pathology that needs to be considered although rare, is acute compartment syndrome that can be the result of trauma or present with an insidious onset . Ultrasound imaging and x-rays are usually a good place to start for differential diagnoses. If you would like to read about other interesting case reports, have a look at the whole database . URL : https://doi.org/10.1016/j.xrrt.2023.05.010 No Abstract Available publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Association between sedentary behavior and dementia: A systematic review and meta-analysis of cohort studies. Luo, et al. (2025) Level of Evidence: 1a Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Aetiologic Topic : Sedentary behaviour - Dementia This systematic review and meta-analysis assessed the relationship between sedentary behavior and the risk of developing dementia. Ten cohort study for a total of more than 2,500,000 participants were included. Of these participants, 1% presented with dementia. Sedentary activity was also divided in watching TV vs utilising a computer. The results demonstrated that sedentary time spent watching television was linked to a higher risk of dementia (low quality evidence), while sedentary behavior due to computer usage showed no significant association with dementia (very low quality of evidence). (a) Meta-analysis of the association between sedentary behavior (defined by TV viewing time) and dementia (b) Meta-analysis of the association between sedentary behavior (defined by computer using time) and dementia (c) Meta-analysis of the association between sedentary behavior (defined by other methods) and dementia. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, not all sedentary behavior has the same effect on brain health. In particular, sedentary behavior associated with computer use does not appear to be as detrimental as watching TV . Overall, we know that physical activity is extremely useful for our patients well-being , however, based on this paper, sedentary activity associated with cognitive load (e.g. computer use) may be beneficial for their brain health too. URL : https://doi.org/10.1186/s12888-025-06887-0 Abstract Objective: This study aimed to assess the association between sedentary behavior (SB) and dementia among the general adult population. Methods: We queried PubMed, Web of Science, Embase, and Cochrane Library from their inception to November 3, 2024. Two authors independently extracted the data from included studies, including hazard ratios (HRs) and their 95% confidence intervals (CIs), to assess the risk of dementia among individuals with SB. The quality of included studies was assessed using the Newcastle–Ottawa Scale. We used a random effects model if I2 > 50% and p < 0.10; otherwise, a fixed-effect model was used. In addition, we assessed publication bias by funnel plot, and performed leave-one-out sensitivity analysis. Results: We included ten cohort studies, nine of which were of high quality. Our analysis demonstrated an increased risk of dementia among individuals with SB (pooled HRs, 1.17; 95% CIs, 1.06–1.29). Individuals with high sedentary time (ST), defined by TV viewing, demonstrated a 31% increased risk of dementia compared to those with low ST (pooled HRs, 1.31; 95% CIs, 1.25–1.37). No significantly increased risk for dementia was observed among individuals with high computer usage time (pooled HRs, 0.89; 95% CIs, 0.73–1.09). However, when SB was defined by other methods, individuals with high ST demonstrated a 33% increased risk of dementia compared to those with low ST (pooled HRs, 1.33; 95% CIs, 1.25–1.42). Conclusion: SB increases the risk of dementia, but SB defined by computer usage time has not shown this association. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

The concentric circles method to define and assess anterior subluxation in bony mallet finger. Lee, et al. (2025) Level of Evidence: 2b Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Diagnostic Topic : Mallet finger - Diagnostic circles This study assessed the new circle method against other in assessing anterior subluxation of the distal interphalangeal joint using radiographs in bony mallets. Three techniques were compared: visual inspection, malalignment method (anterior shift of the distal phalanx axis compared to proximal phalanx), and a new concentric circles method. The research involves 114 bony mallets and the diagnostic outcome of inexperience radiologists were compared to two senior hand surgeons. The results showed that the concentric circles method shows the highest agreement with expert assessments, demonstrating its reliability and objectivity. This method simplifies evaluating joint congruency into a reproducible process, by pacing a circle through the proximal phalanx head and a circle aligned with the distal phalanx articular surface (see picture below). Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, the concentric circles method appears to be valid and reliable way of assessing anterior subluxation of the distal interphalangeal joint in bony mallets. This may be a useful diagnostic approach in those borderline cases where the fracture involves more than 1/3 of the articular cartilage and follow up x-rays are required. Keep in mind that if there is no anterior subluxation of the distal phalanx in bony mallets, conservative management or pinning obtain similar outcomes . If you are interested in the management of mallet fingers, have a look at the entire database on the topic . URL : https://doi.org/10.1177/17531934251348121 Abstract We have described and validated the concentric circles method for assessing anterior subluxation in the bony mallet finger. We retrospectively analysed 114 radiographs from cases of bony mallet finger assessed by four hand surgeons and one radiologist using three approaches: subjective visual inspection, the concentric circles method and the malalignment method. The concentric circles method defines subluxation as a disruption of the normal concentric annulus between the middle phalangeal head and distal phalangeal articular surface on true lateral radiographs. It showed improved accuracy (94%), higher sensitivity (91%) and specificity (97%) compared with the other methods, with excellent inter- and intra-observer reliabilities. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Level of Evidence: 5 Follow recommendation: 👍 (1/4 Thumbs up) Type of study: Diagnostic A 53 years old patient presented to ED following an elbow dislocation due to a FOOSH, which spontaneously reduced after standing up from the fall. The patient reported extreme pain, radial artery pulselessness, forearm edema, hand numbness, and no clear fracture signs on X-rays, though CT revealed small non-displaced radial and medial condile fractures (see images below). What is it?

Nail bed injury repair: Nail plate replacement versus non-replacement. Rock, et al. (2024) Level of Evidence: 2b Follow recommendation: 👍👍👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Nail plate adults - Replace or discard This randomised controlled study investigated whether replacing the nail plate after nail bed repair affects outcomes such as nail regrowth, cosmetic appearance, and patient satisfaction. A total of 50 participants were randomised to: replacing the nail plate or using substitutes like foil or silicone. The results showed no significant difference between groups in terms of nail regrowth, cosmesis, or patient satisfaction. Both approaches yielded similar outcomes, suggesting that replacing the nail plate may not offer additional benefits. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, replacing the nail plate with substitutes like foil or silicone does not appear to provide significant benefits in terms of nail regrowth, cosmetic appearance, and patient satisfaction. This seems to be in line with a previous retrospective study in children . URL : https://pmc.ncbi.nlm.nih.gov/articles/PMC11367160/ Abstract Background: Although nail bed injuries are common, there is no consensus on the proper course of treatment in regard to nail plate replacement. Nail plate replacement risks infection and injury of the germinal matrix. It is our hypothesis that functional and cosmetic outcomes of the nail will not differ by nail plate replacement following nail bed repair. Methods: This is a single institution, prospective, randomized control study comparing nail plate replacement versus non-replacement in patients undergoing nail bed repair. Primary outcome included nail growth and cosmesis using the Zook classification system. Secondary outcomes were pain, functional limitation, and patient satisfaction. Statistical significance was set at P < .05. Results: Fifty patients were enrolled, 26 (52%) randomized to the non-replacement group and 24 (48%) to the replacement group. All patients who followed up had nail growth by 4 months after nail bed repair (N = 28). In the non-replacement group 4 patients continued to have pain in the affected nail bed compared with 2 patients in the replacement group (P = .66). One patient in each group reported continued functional limitation related to nail pain (P = 1.00). Patient satisfaction was not statistically different between the groups (P = 1.00). As a result of patient follow- up, we have been able to score 17 patients via the Zook criteria. In the non-replacement group, 3 nails were scored as excellent, 3 very good, 3 good, 1 fair, and 2 poor. In the replacement group, the nail was classified as excellent in 4 patients and very good in 1 patient. There was no difference in the likelihood of these outcomes with regard to treatment group (P = .18). There was moderate agreement between patient satisfaction and the Zook criteria scoring (κ = .45, 95% CI: –0.15-1.00). Conclusions: Statistical and clinical differences were not identified in regard to cosmesis, pain, functional use of the hand, or patient satisfaction. There are established risks involved in nail plate replacement such as infection and injury to the germinal matrix. If outcomes are not different based on nail plate replacement following nail bed repair, non- replacement may be the preferable treatment option so as to avoid these complications. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

Effectiveness of nail bed repair in children with or without replacing the fingernail: Ninja multicentre randomized clinical trial. Jain, et al. (2023) Level of Evidence: 1b- Follow recommendation: 👍 👍 👍 (3/4 Thumbs up) Type of study: Therapeutic Topic : Nailbed injury children - Replacement This randomised controlled trial named NINJA (Nail bed INJury Analysis) compared two methods for managing nail bed injuries in children: replacing the nail plate versus discarding it after repair. The study involved 440 participants across multiple centers and aimed to assess the effectiveness, safety, and cost-efficiency of these approaches. Both methods resulted in similar satisfaction regarding nail appearance and function. However, discarding the nail plate was associated with fewer complications, such as pain and was also found to be more cost-effective. Importantly, there were no statistical significant differences in infection rates between the two groups. The researchers concluded that discarding the nail plate is generally preferable unless specific clinical circumstances, such as significant alignment issues or reconstructive needs, dictate otherwise. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, nail replacement in children does not present with benefits compared to discarding the nail in most instances . This seems to be in line with previous evidence from a retrospective pediatric study and a randomised controlled trial in adults . URL : https://doi.org/10.1093/bjs/znad031 Abstract Background: Surgery for nail bed injuries in children is common. One of the key surgical decisions is whether to replace the nail plate following nail bed repair. The aim of this RCT was to assess the clinical effectiveness and cost-effectiveness of nail bed repair with fingernail replacement/substitution compared with repair without fingernail replacement. Methods: A two-arm 1 : 1 parallel-group open multicentre superiority RCT was performed across 20 secondary-care hospitals in the UK. The co-primary outcomes were surgical-site infection at around 7 days after surgery and cosmetic appearance summary score at a minimum of 4 months. Results: Some 451 children presenting with a suspected nail bed injury were recruited between July 2018 and July 2019; 224 were allocated to the nail-discarded arm, and 227 to the nail-replaced arm. There was no difference in the number of surgical-site infections at around 7 days between the two interventions or in cosmetic appearance. The mean total healthcare cost over the 4 months after surgery was €84 (95 per cent c.i. 34 to 140) lower for the nail-discarded arm than the nail-replaced arm (P &lt; 0.001). Conclusion: After nail bed repair, discarding the fingernail was associated with similar rates of infection and cosmesis ratings as replacement of the finger nail, but was cost saving. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings

What’s new in wound healing: Treatment advances and microbial insights. Beraja, et al. (2025) Level of Evidence: 4 Follow recommendation: 👍 👍 (2/4 Thumbs up) Type of study: Therapeutic Topic : Wound debridement - Mechanical This narrative review highlights rapid advancements in wound healing therapies, emphasising the importance of wound microbiology and adopting innovative approaches to improve patient outcomes. Key therapies include exosomes, which show promise for burns and ulcers but require further standardisation; low-level light therapy, effective with specific wavelengths and settings; electrical stimulation therapy, demonstrated to significantly reduce ulcer sise and pain; and extracorporeal shock wave therapy, suggested to accelerate healing in burns and diabetic foot ulcers. The authors underscore the importance of wound bed preparation for healing and management of infections. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message : Based on what we know today, wound bed preparation appears to be an important aspect of wound healing. Mechanical debridement, amongst other more sofisticated options may reduce the likelihood of infection and speed up recovery. Other strategies that appear to be useful in improving wound healing include the assumption of Vitamin C and light aerobic exercise . Whilst it appears that mental stress impairs healing , there is limited evidence suggesting that relaxation approaches can improve wound healing . URL : https://doi.org/10.1007/s40257-025-00953-9 Abstract Recent advancements in wound healing are reshaping clinical practice by integrating dermatology, cutaneous microbiome research, and technology. This article discusses new diagnostic tools, such as imaging devices and microbial composition analysis, that enhance our understanding of wound environments. It highlights the importance of wound bed preparation and explores innovative treatment methods for optimal wound healing, including debridement techniques like ultrasound-assisted methods, hydrosurgery, and larval therapy. The evolution of wound management is further illustrated through the use of cellular and acellular matrix products and cellular therapies involving whole blood products. We also present the latest insights on the wound microbiome and antimicrobial treatments, including advanced dressings and antibiofilm surfactants. Finally, the potential of gene therapy for complex conditions like epidermolysis bullosa is discussed as a promising model for advancing wound healing. This review synthesizes current research to improve dermatological practices and patient outcomes in wound care. publications = Total number of papers citing this research supporting = Citation statements supporting the findings mentioning = Neutral citation statements contrasting = Citation statements not supporting the findings